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view-id-bmj_rapid_responses view-display-id-bmj_rr_article view-dom-id-e48bd4c34df9b535b1e767e9da7d7272\u0022\u003E\n \u003Cdiv class=\u0022view-header\u0022\u003E\n \u003Cdiv id=\u0022response-header-description\u0022\u003ERapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. \u003Cem\u003EThe BMJ\u003C\/em\u003E reserves the right to remove responses which are being wilfully misrepresented as published articles.\u003C\/div\u003E \u003C\/div\u003E\n \n \u003Cdiv class=\u0022view-filters\u0022\u003E\n \u003Cform action=\u0022\/\u0022 method=\u0022get\u0022 id=\u0022views-exposed-form-bmj-rapid-responses-bmj-rr-article\u0022 accept-charset=\u0022UTF-8\u0022\u003E\u003Cdiv\u003E\u003Cdiv class=\u0022views-exposed-form\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widgets clearfix\u0022\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-by\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-by form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-by\u0022\u003ESort by \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-by\u0022 name=\u0022sort_by\u0022\u003E\u003Coption value=\u0022field_highwire_a_epubdate_value\u0022 selected=\u0022selected\u0022\u003EDate Published\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-sort-order\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-sort-order form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-sort-order\u0022\u003EOrder \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-sort-order\u0022 name=\u0022sort_order\u0022\u003E\u003Coption value=\u0022ASC\u0022\u003EAscending\u003C\/option\u003E\u003Coption value=\u0022DESC\u0022 selected=\u0022selected\u0022\u003EDescending\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-widget-per-page\u0022\u003E\n \u003Cdiv class=\u0022form-type-select form-item-items-per-page form-item form-group\u0022\u003E\n \u003Clabel for=\u0022edit-items-per-page\u0022\u003EItems per page \u003C\/label\u003E\n \u003Cselect class=\u0022form-control form-select\u0022 id=\u0022edit-items-per-page\u0022 name=\u0022items_per_page\u0022\u003E\u003Coption value=\u00225\u0022\u003E5\u003C\/option\u003E\u003Coption value=\u002210\u0022 selected=\u0022selected\u0022\u003E10\u003C\/option\u003E\u003Coption value=\u002220\u0022\u003E20\u003C\/option\u003E\u003Coption value=\u002240\u0022\u003E40\u003C\/option\u003E\u003Coption value=\u002260\u0022\u003E60\u003C\/option\u003E\u003C\/select\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-exposed-widget views-submit-button\u0022\u003E\n \u003Cinput class=\u0022btn btn-info form-submit\u0022 type=\u0022submit\u0022 id=\u0022edit-submit-bmj-rapid-responses\u0022 name=\u0022\u0022 value=\u0022Apply\u0022 \/\u003E \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/form\u003E \u003C\/div\u003E\n \n \n \u003Cdiv class=\u0022view-content\u0022\u003E\n \u003Cdiv class=\u0022views-row views-row-1 views-row-odd views-row-first\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/365\/bmj.l2226\/rr-3\u0022\u003E\u003Ch3\u003EEthnic minority patients need equity not just equality\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EKmietowicz refers to disparities affecting ethnic minorities across the health service [1].\u003C\/p\u003E\n\u003Cp\u003EIt is widely accepted that race is a social rather than biological construct used to explain cultural differences, and as such ethnicity is rarely used to guide clinical practice. Indeed, some studies demonstrate that there is more genetic variation within a race than between races [2]. However, new clinical trials should make us reconsider whether being racially blind can also be harmful when deciding on treatment. Currently, the preference for calcium channel blockers over ACE inhibitors in the treatment of hypertension in Afro-Carribean patients represents one of the only concessions to racial differences represented in the national guidelines. There is surmounting evidence from clinical trials suggesting that ethnic minorities do not respond to recommended treatment in the same way as Caucasian patients, to the point that certain populations may not be being treated at all. Where treatments are largely guided by national guidelines, can we really treat individuals in a multicultural population in the same way?\u003C\/p\u003E\n\u003Cp\u003EA 2018 meta-analysis of randomised control trials comparing response to alendronate in East Asian and non-East Asian post-menopausal women found that although bone mineral density increased in both groups, the statistically significant risk reduction of vertebral fractures seen in non-East Asians was not seen in East Asians [3]. The difference in response is supported by the broad genetic variation found between Caucasian and Asian populations that suggest Caucasians are more likely to have a positive response to bisphosphonate therapy [4]. Current treatment guidelines favour Caucasian populations by recommending bisphosphonates, such as alendronate, as first line primary prevention of osteoporotic fragility fractures [5]. Furthermore, bone mineral density is used as a measure of drug response but results from this trial imply that the correlation between bone mineral density and fragility fractures is not as robust in East Asian women. These findings are limited by a small sample size, but it does question whether the current approach is leaving East Asian women at greater risk.\u003Cbr \/\u003E\nEthnic minorities may be at increased risk of adverse effects from standard doses of anticoagulants and antiplatelet medications. \u003C\/p\u003E\n\u003Cp\u003EA genetic study in 2019 revealed that Asians often have lower warfarin requirements compared to Caucasians [6]. This difference may be due to genetic variation between CYP450 enzyme in ethnic groups, as mutations in these genes changed the average daily warfarin dosing requirements. The dosing of warfarin is notoriously complex. However, aggressive dosing of warfarin in the initial phase exposes patients to increased risk of bleeding, which can be catastrophic if it occurs in the brain or the gastrointestinal tract. This study suggests that East Asians may be overdosed on warfarin in the initial phase. However, the generalisability of this trial is limited by its small sample size, which is itself limited to patients in the city of Los Angeles. \u003C\/p\u003E\n\u003Cp\u003EA 2019 meta-analysis of seven randomised control trials suggested that the dosing of dual antiplatelet therapy [7], which has been optimised for a Caucasian population, may be inappropriate for the treatment of East Asian patients. The standard dose of aspirin and clopidogrel led to an unacceptably high bleeding risk in East Asian populations (hazard ratio [HR], 2.843). By contrast, although the non-East Asians had a slightly higher risk of cardiac events compared to East Asians (1.8% vs. 0.8%), there was no significant increase in the rate of bleeding. As the first tenet of medicine is \u201cto do no harm,\u201d it may be appropriate to lower the dose or shorten the duration of DAPT in East Asians in order to optimise the risk ratio between bleeding and ischaemia. \u003C\/p\u003E\n\u003Cp\u003EEthnic minorities are underrepresented in clinical trials and as a result written out of treatment guidelines. It is the responsibility of clinicians to \u2018provide effective treatment based on the best available evidence\u2019 [8], and this should encompass evidence about treatments for different population groups. By ignoring these differences, we are failing 14% of the country [9] by prescribing ineffectively or even causing harm. \u003C\/p\u003E\n\u003Cp\u003E1. Kmietowicz, Z., Ladher, N., Rao, M., Salway, S., Abbasi, K. and Adebowale, V. (2019). Ethnic minority staff and patients: a health service failure. BMJ, p.l2226.\u003Cbr \/\u003E\n2. Gannon, M. (2016). Race Is a Social Construct, Scientists Argue. [online] Scientific American. Available at: \u003Ca href=\u0022https:\/\/www.scientificamerican.com\/article\/race-is-a-social-construct-scientists-argue\/\u0022\u003Ehttps:\/\/www.scientificamerican.com\/article\/race-is-a-social-construct-sc...\u003C\/a\u003E [Accessed 29 Jul. 2019].\u003Cbr \/\u003E\n3. Wang, Y., Jia, G., Song, J., Kong, X., Zhang, W. and Meng, C. (2018). Comparative Efficacy of Alendronate upon Vertebral Bone Mineral Density and Fracture Rates in East Asians Versus Non-East Asians with Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis. Hormone and Metabolic Research, 50(10), pp.738-746.\u003Cbr \/\u003E\n4. Olmos, J., Zarrabeitia, M., Hern\u00e1ndez, J., Sa\u00f1udo, C., Gonz\u00e1lez-Mac\u00edas, J. and Riancho, J. (2010). Common allelic variants of the farnesyl diphosphate synthase gene influence the response of osteoporotic women to bisphosphonates. The Pharmacogenomics Journal, 12(3), pp.227-232.\u003Cbr \/\u003E\n5. Pathways.nice.org.uk. (2019). Osteoporosis - NICE Pathways. [online] Available at: \u003Ca href=\u0022https:\/\/pathways.nice.org.uk\/pathways\/osteoporosis\u0022\u003Ehttps:\/\/pathways.nice.org.uk\/pathways\/osteoporosis\u003C\/a\u003E [Accessed 29 Jul. 2019].\u003Cbr \/\u003E\n6. Mak, M., Lam, C., Pineda, S., Lou, M., Xu, L., Meeks, C., Lin, C., Stone, R., Rodgers, K. and Mitani, G. (2019). Pharmacogenetics of Warfarin in a Diverse Patient Population. Journal of Cardiovascular Pharmacology and Therapeutics, p.107424841984353.\u003Cbr \/\u003E\n7. Kang, J., Park, K., Palmerini, T., Stone, G., Lee, M., Colombo, A., Chieffo, A., Feres, F., Abizaid, A., Bhatt, D., Valgimigli, M., Hong, M., Jang, Y., Gilard, M., Morice, M., Park, D., Park, S., Jeong, Y., Park, J., Koo, B. and Kim, H. (2018). Racial Differences in Ischaemia\/Bleeding Risk Trade-Off during Anti-Platelet Therapy: Individual Patient Level Landmark Meta-Analysis from Seven RCTs. Thrombosis and Haemostasis, 119(01), pp.149-162.\u003Cbr \/\u003E\n8. Gmc-uk.org. (2019). Good Medical Practice. [online] Available at: \u003Ca href=\u0022https:\/\/www.gmc-uk.org\/ethical-guidance\/ethical-guidance-for-doctors\/good-medical-practice\/domain-1---knowledge-skills-and-performance#paragraph-14\u0022\u003Ehttps:\/\/www.gmc-uk.org\/ethical-guidance\/ethical-guidance-for-doctors\/goo...\u003C\/a\u003E [Accessed 29 Jul. 2019].\u003Cbr \/\u003E\n9. Ethnicity-facts-figures.service.gov.uk. (2019). Population of England and Wales. [online] Available at: \u003Ca href=\u0022https:\/\/www.ethnicity-facts-figures.service.gov.uk\/uk-population-by-ethnicity\/national-and-regional-populations\/population-of-england-and-wales\/latest\u0022\u003Ehttps:\/\/www.ethnicity-facts-figures.service.gov.uk\/uk-population-by-ethn...\u003C\/a\u003E [Accessed 29 Jul. 2019].\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E30 July 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Selena R Yang \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Foundation doctor \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n London \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-2 views-row-even\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/365\/bmj.l2226\/rr-2\u0022\u003E\u003Ch3\u003ERe: Ethnic minority staff and patients: a health service failure\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EI wholly agree on the systematic racism that exists within the NHS. I also believe much of it is largely unintentional, unconscious bias. Having only just completed a year in a district general hospital that serves a largely deprived, BAME population that also boasts a high proportion of BAME doctors one would think cultural understanding would also ensue and translate into better treatment. \u003C\/p\u003E\n\u003Cp\u003EUnfortunately what often ends up happening is that BAME staff who are keen for professional respect and courtesy are often less sympathetic to patients from a background they share, in what I believe is their effort towards acceptance that they crave from their colleagues. The desire to be accepted is undoubtedly a natural one and as the article suggests those who are not feel bullied and are overlooked professionally. Unfortunately, I have seen this comes at the cost of the patient. \u003C\/p\u003E\n\u003Cp\u003EI have to admit, even for myself, it is a conscious battle not to belittle the concerns of a BAME patient. One has to question why that is? I think a large part of it is language and a learnt description of symptoms from medical school. We are often oblivious to the fact we are being taught from a certain perspective, Questions and revision material only add to this by testing candidates on typical scenarios, often racially driven. Are we properly equipped at medical school for the cultural diversity of the NHS?\u003C\/p\u003E\n\u003Cp\u003EThere are well known stereotypes such as Bibi syndrome or Begum syndrome which are often colloquially used to describe South Asian patients with non-specific complaints. These only serve to undermine patients and as this article points out contribute to health inequality. \u003C\/p\u003E\n\u003Cp\u003EThe issue is multi-faceted, I am glad data gathering is taking place to identify the issue. So much needs to be done in working toward ensuring the NHS is a service to all. \u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E03 July 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Tay-yibah Mohamed \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Foundation Doctor \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n None \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Birmingham \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-3 views-row-odd\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/365\/bmj.l2226\/rr-1\u0022\u003E\u003Ch3\u003EThe ethnicity of Dr Google\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EI look forward to this special issue, in particular further information regarding attitudes towards NHS staff in terms of complaints which can be arbitrary and dependent on bias (conscious or not). \u003C\/p\u003E\n\u003Cp\u003EA cursory look at the results of a google image search for the term \u201cdoctor\u201d reveals a disparity between expectation and reality. Of the first 10 healthcare professionals that appear, every single one appears to show a someone who seems to be from a white background.\u003C\/p\u003E\n\u003Cp\u003EOf course, we have to bear in mind that the image search is likely to include a high proportion stock images where advertising companies use photo models to portray doctors. Nevertheless, such imagery is pervasive throughout our society, whether it is online, on television or in advertising.\u003C\/p\u003E\n\u003Cp\u003EIs it therefore surprising that when patients do access healthcare, their preconceived image of what a doctor should look like can be very different from their actual experience? Do mismatches between expectation and reality increase the likelihood of a complaint?\u003C\/p\u003E\n\u003Cp\u003EPerhaps even more pernicious is the effect such imagery could be having on potential medical school applicants who may feel they have to conform to such stereotypes to gain access to the club (or not bothering to apply at all).\u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n Blogger at https:\/\/unexaminedmedicine.org\/\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E01 June 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Sati Heer-Stavert \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n GP \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n UK \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/@SatiHeerStavert\u0022\u003E@SatiHeerStavert\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-4 views-row-even\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/365\/bmj.l2226\/rr-0\u0022\u003E\u003Ch3\u003EEthnic minority staff\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EChecking the Government website today (\u003Ca href=\u0022http:\/\/www.gov.uk\u0022\u003Ewww.gov.uk\u003C\/a\u003E), it gives this overview of the duty of equality across public services including the National Health Service (NHS):\u003Cbr \/\u003E\n\u0022The public sector Equality Duty (PSED) requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations between different people when carrying out their activities.\u0022\u003C\/p\u003E\n\u003Cp\u003EPoorer quality care for patients from ethnic minorities has been documented in many British institutions.[1] In this letter I will focus on the inequalities experienced by clinicians from Black and Minority Ethnic groups (BME). A wise colleague (and fellow teacher) told me this starts long before BME professionals are in practice. So I began by looking just one step before professional practice. To qualify in the UK, clinicians all spent extended periods in higher education. Recent research in two multi-disciplinary London universities by AdvanceHE [2] was driven by the same need to enhance diversity at the top of organisations described in this Editorial.[1] Discrimination is already present in academia. However, participants in a Diversifying Leadership programme reported \u201cthat using diverse role models and speakers can help convey the message that leadership can take many forms and can incorporate different identities and cultural backgrounds.\u201d[2] Equality of recognition and promotion came up as sensitive issues for many BME staff. Over the year of the Diversifying Leadership programme, ratings of \u201cMy formal appraisal\/performance review is useful\/ valuable\u201d improved significantly. \u003C\/p\u003E\n\u003Cp\u003EHere are three recommendations for developing new academic leaders,[2] that might also apply to the NHS:\u003Cbr \/\u003E\na.\tPay particular attention to the advertising strategies employed for senior posts, identifying ways to increase the breadth of the audience reached.\u003Cbr \/\u003E\nb.\tInitiate discussions with BME staff to explore what barriers they face to progression and leadership within the institution and more broadly.\u003Cbr \/\u003E\nc.\tImplement equality impact assessments as a standard accompaniment to all decision-making agenda items. \u003C\/p\u003E\n\u003Cp\u003EActually, these recommendations are a Duty.\u003C\/p\u003E\n\u003Cp\u003E1.\tKmietowicz Z, Ladher N, Rao M, Salway S, Abbassi K, Adebowale V. Ethnic minority staff and patients: a health service failure. BMJ 2019;365:l2226\u003Cbr \/\u003E\n2.\tFook J, Archibong U, Kim T, Aldercotte A. Cracking the concrete ceiling: Tracking the impact of the Diversifying Leadership programme. London, AdvanceHE, 2019. \u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E23 May 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n Woody Caan \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Occasional teacher or trainer \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Duxford, Cambridge \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003Cdiv class=\u0022views-row views-row-5 views-row-odd views-row-last\u0022\u003E\n \r\n\u003Cdiv class=\u0022node node-highwire-comment node-promoted clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022row rr-header\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022rr-left-column\u0022 class=\u0022\u0022\u003E\r\n\r\n \r\n \u003Cdiv class=\u0022response-title\u0022\u003E\r\n \u003Ca href=\u0022\/content\/365\/bmj.l2226\/rr\u0022\u003E\u003Ch3\u003ERe: Ethnic minority staff and patients: a health service failure\u003C\/h3\u003E\r\n \u003C\/a\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \r\n \r\n \u003Cdiv class=\u0022content\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022response-body\u0022\u003E\r\n \u003Cp\u003EIt would be interesting to see what the special issue turns up.\u003C\/p\u003E\n\u003Cp\u003EI have always classified myself in questionnaires from the DHSS, from the local authorities, etc, as merely Homo sapiens and crossed off the dozen or so boxes asking, in effect, whether one is a green man or blue. \u003C\/p\u003E\n\u003Cp\u003ECensus forms? I treat them the same - with contempt. \u003C\/p\u003E\n\u003Cp\u003EI am sure that the health service has sometimes attributed to me an \u201cethnicity\u201d without consulting me. \u003C\/p\u003E\n\u003Cp\u003EJust in case someone wishes to gift to me the tartan of the Clan Annand or Anan - I will accept it with thanks, but I would like to clarify that my ancestry does not include any Scottish chromosomes. As far as I know. \u003C\/p\u003E\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-competing\u0022\u003E\r\n \u003Cp\u003E\u003Cstrong\u003ECompeting interests: \u003C\/strong\u003E\r\n No competing interests\u003C\/p\u003E\r\n \u003C\/div\u003E\r\n\r\n \r\n \u003C\/div\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-right-column\u0022 class=\u0022\u0022\u003E\r\n \u003Cdiv class=\u0022response-date\u0022\u003E\r\n \u003Cstrong\u003E23 May 2019\u003C\/strong\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-author\u0022\u003E\r\n JK Anand \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-occupation\u0022\u003E\r\n Retired doctor \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-other_authors\u0022\u003E\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-affiliation\u0022\u003E\r\n Free spirit \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-address\u0022\u003E\r\n Peterborough \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022twitter-address\u0022\u003E\r\n \u003Ca href=\u0022https:\/\/twitter.com\/\u0022\u003E\u003C\/a\u003E \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022response-links\u0022\u003E\r\n\r\n \r\n \r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003Cdiv class=\u0022rr-separator\u0022 class=\u0022clearfix\u0022\u003E\r\n\r\n \u003Cdiv class=\u0022light-grey-line\u0022\u003E\u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n \u003C\/div\u003E\r\n\r\n\u003C\/div\u003E\r\n \u003C\/div\u003E\n \u003C\/div\u003E\n \n \n \n \n \n \n\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003C\/body\u003E\u003C\/html\u003E"}